International Distributor Questionnaire

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Contact Name Required

Phone Number Required

Email Required What is the complete name of your company? Required When was your company founded? Required What is your company’s yearly sales revenue Required Do you have a website? Required What dialysis products do you currently sell? Required What specific territory do you cover and what territories are you interested in covering? Required How do you currently market and promote the products you currently distribute? Required How will you promote our products in your market? Required Can you identify the types of customers who will buy our product line? Required What’s your plan for building our brand in your country? Required Do you have good market coverage, including a trained and educated sales force? Required What are your sales projections for our products? Required What is your ship to address? Required Do you have a shipper’s account (FedEx, UPS, DHL) or use an existing USA-based freight forwarder? Required For all international customers, RPC requires advanced payment in US currency via wire transfer. Are you able to comply? Required

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